Healthcare Provider Details

I. General information

NPI: 1720184237
Provider Name (Legal Business Name): BETTY JANE EVANS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 JEFFERSON AVE CARDIOLOGY SECTION
MEMPHIS TN
38104-2127
US

IV. Provider business mailing address

3755 OAK BARK LN
BARTLETT TN
38135-2480
US

V. Phone/Fax

Practice location:
  • Phone: 901-577-7361
  • Fax: 901-577-7531
Mailing address:
  • Phone: 901-387-0509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number032555
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: